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. 2021 Jul 20;10(14):3186.
doi: 10.3390/jcm10143186.

Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma: Clinical Patterns, Outcomes, and Prognostic Factors for Overall Survival-A Retrospective Analysis of a Slovak Cohort

Dominik Safcak  1 , Sylvia Drazilova  2   3 , Jakub Gazda  3 , Igor Andrasina  1 , Svetlana Adamcova-Selcanova  4 , Radovan Barila  5 , Michal Mego  6 , Marek Rac  7 , Lubomir Skladany  4 , Miroslav Zigrai  8 , Martin Janicko  3 , Peter Jarcuska  3
Affiliations

Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma: Clinical Patterns, Outcomes, and Prognostic Factors for Overall Survival-A Retrospective Analysis of a Slovak Cohort

Dominik Safcak et al. J Clin Med. .

Abstract

Objective: To compare NAFLD-related HCC and other etiology-related HCC and to describe predictive factors for survival in patients with NAFLD-related HCC independent of the BCLC staging system.

Methods: We performed a multicenter longitudinal retrospective observational study of patients diagnosed with HCC during the period from 2010 through 2016.

Results: 12.59% of patients had NAFLD-related HCC, and 21.91% had either NAFLD or cryptogenic etiology. NAFLD-related HCC patients were younger (p = 0.0007), with a higher proportion of women (p < 0.001) compared to other etiology-related HCC patients. The NAFLD group had a significantly lower proportion of patients with liver cirrhosis at the time of HCC diagnosis (p < 0.0001), and they were more frequently diagnosed with both diabetes and metabolic syndrome when compared to other etiology-related HCC (p < 0.0001). We did not find any difference in the overall survival or in the progression-free survival between NAFLD-related and other etiology-related HCC patients staged as BCLC B and BCLC C. NAFLD-related HCC patients with three or more liver lesions had a shorter overall survival when compared to patients with one or two liver lesions (p = 0.0097), while patients with baseline CRP values of ≥5 mg/L or with PLR ≥ 150 had worse overall survival (p = 0.012 and p = 0.0028, respectively). ALBI Grade 3 predicted worse overall survival compared to ALBI Grade 1 or 2 (p = 0.00021). In NAFLD-related HCC patients, PLR and ALBI remained significant predictors of overall survival even after adjusting for BCLC.

Conclusion: NAFLD-related HCC patients have a similar prognosis when compared to other etiology-related HCC. In NAFLD-related HCC patients, ALBI and PLR are significant predictors of the overall survival independent of the BCLC staging system.

Keywords: cirrhosis; hepatocellular cancer; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis; overall survival; prognostic factors.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient inclusion.
Figure 2
Figure 2
(A) Overall survival of NAFLD-related HCC patients. (B) Disease-/progression-free survival of NAFLD-related HCC patients. (C) Overall survival of NAFLD-related HCC patients stratified by age (cut-off, 70 years).
Figure 3
Figure 3
(A) Overall survival of patients with NAFLD- and other etiology-related BCLC B HCC. (B) Progression-free survival of patients with NAFLD- and other etiology-related BCLC B HCC.
Figure 4
Figure 4
(A) Overall survival of patients with NAFLD- and other etiology-related BCLC C HCC. (B) Progression-free survival of patients with NAFLD- and other etiology-related BCLC C HCC.
Figure 5
Figure 5
(A) Overall survival of NAFLD-related HCC patients stratified by the number of liver lesions. (B) Overall survival of NAFLD-related HCC patients stratified by the diameter of the largest lesion (cut-off value, 50 mm).
Figure 6
Figure 6
(A) Overall survival of NAFLD-related HCC patients stratified by the baseline CRP value (cut-off, 5 mg/L). (B) Overall survival of NAFLD-related HCC patients stratified by the baseline NLR (cut-off, 2.5). (C) Overall survival of NAFLD-related HCC patients stratified by the baseline PLR (cut-off, 150).
Figure 7
Figure 7
(A) Overall survival of NAFLD-related HCC patients stratified by the baseline AFP value (cut-off, 10 and 100 kIU/L). (B) Overall survival of NAFLD-related HCC patients stratified by ALBI grade. (C) Overall survival of NAFLD-related HCC patients with normal and increased serum aminotransferases.
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